Provider Demographics
NPI:1033360920
Name:IGNACIO, SAMUEL BADAS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BADAS
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AUTUMN CIR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1605
Mailing Address - Country:US
Mailing Address - Phone:914-843-8224
Mailing Address - Fax:
Practice Address - Street 1:21 AUTUMN CIR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1605
Practice Address - Country:US
Practice Address - Phone:914-843-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01119-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist